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AVITA PHARMACY 1034
RWII78667 Community Action, Inc. of Central Texas
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Covered Entity Details
Entity Name
Community Action, Inc. of Central Texas
Subdivision Name
Type
Ryan White Part B
340B ID
RWII78667
Entity Address
215 S. Reimer Avenue Suite 140
San Marcos, TX 78666
Grant Number
X07HA00054
Participating Start Date
7/1/2019
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1034
Pharmacy Address
340B PARTNERS PHARMACY-DALLAS LLC DBA AV
2800 S IH-35 FRONTAGE RD.
STE 105
AUSTIN, TX 78704
Pharmacy Comments
Contract Details
Approval Date
1/9/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Douglas Mudd, Executive Director
(512) 392-1161 Ext: 332
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
1/9/2023
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